4  Discussion and recommendations
Data from a large sample of users of a national DMHS reveals a significant early psychological impact of the COVID-19 pandemic on the Australian community. There have been large increases in website visits, and number and duration of calls to the clinic when compared to a comparison period. Overall numbers of patients accessing online assessment services significantly increased. There are several possible reasons for the increased demand for MindSpot services, including increased distress levels in the population, the temporary closure of existing face-to-face services, and increased promotion of MindSpot by other services that were unable to meet patients' needs.
Patients using MindSpot during this early pandemic period reported a broad range of concerns, including greater anxiety, but also concerns about issues such as where to access COVID-19 tests, financial insecurity, and how to adjust to isolation and other changes in lifestyle, including having children at home, being unable to visit family members and friends, and advice about supporting people in isolation. Many of these challenges involve themes of loss and adjustment, but also reflect exacerbation of existing tensions within families or workplaces.
While most users acknowledged concern about COVID-19, there was only a small but significant increase in the level of symptoms of anxiety, and no increase on measures of depression, overall psychological distress, or suicidal thoughts. Few people have themselves had COVID-19 or even know of someone who has it, and the reasons reported by people for contacting the clinic include fear and uncertainty, the practical effect of the economic shutdown and changes in lifestyle and routine.
We found that older adults, who are typically more stoical in their rating of mood symptoms, had higher levels of concern than younger adults. Anecdotally, our therapists reported that people contacting the service who are themselves health workers or are in other front-line services dealing with the public are often highly anxious about their own health, which is also understandable given the alarming reports of deaths among frontline doctors and nurses elsewhere (Fusaroli et al., 2020).
The study was conducted early in the pandemic in Australia before the health effects have been widely felt. We have not yet detected increased alcohol abuse, domestic violence and other manifestations of familial discord, or anxiety of senior school students and university students about their future prospects from protracted closure of colleges and cancellation of exams. We also did not find an increase in patients reporting suicidal thoughts or plans, as might have been expected. However, given the current predictions of the need for long term reduction in social contact to slow the spread of infection, those concerns may emerge in time.
The current study provides evidence of behavioural changes and mental health concerns in response to the COVID-19 pandemic. Limitations include the use of a comparison group from a period six months past. However, the period of September 2019 was selected following analyses indicating it represented the “usual” patient profile (Titov et al., 2020 submitted for publication), and avoided the period immediately prior to March 2020 during which Australia experienced a severe bushfire crisis that disrupted the summer holiday period and affected the major cities. It is possible that the demographics and symptoms of the comparison and COVID-19 groups reported here differ for reasons unrelated to the COVID-19 crisis, although given the remarkably consistent characteristics of MindSpot users we believe that to be unlikely.